Provider Demographics
NPI:1497076491
Name:CARLSON, SEBASTIAN RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:RICHARD
Last Name:CARLSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-1009
Mailing Address - Country:US
Mailing Address - Phone:805-252-4453
Mailing Address - Fax:
Practice Address - Street 1:521 PARNASSUS AVE RM C522
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0440
Practice Address - Country:US
Practice Address - Phone:805-252-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program